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Background: It remains unclear whether preoperative blood donation is truly beneficial in liver surgery. The aim of this study was to compare surgical outcomes between patients receiving autologous and homologous transfusions during liver resection for biliary tract cancer (BTC)., Methods: Patients who underwent hepatectomy for BTC were retrospectively reviewed (2006-2017). Patients who deposited autologous blood and underwent resection without homologous blood transfusion intraoperatively (Autologous group) were compared with non-depositing patients who required homologous transfusion during hepatectomy (Homologous group). Propensity score matching analyses were performed to adjust the data for the baseline characteristics of both groups., Results: During the study period, 359 patients were included in the Autologous group, and 105 patients were in the Homologous group. The postoperative maximum total bilirubin (T-Bil) levels and the incidence of postoperative liver failure were significantly higher in the Homologous group than in the Autologous group. After propensity score matching, postoperative maximum T-Bil levels were significantly higher in the Homologous group, whereas the incidence of postoperative liver failure was comparable between the two groups; between-group differences were not observed for the remaining major complications, hospital stays and mortality., Conclusion: Although autologous blood transfusion may minimize postoperative hyperbilirubinemia, it may not decrease the risk for mortality or morbidities following hepatectomy for BTC., (© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Objective: The hemolytic product free-hemoglobin (fHb) reduces nitric oxide (NO) bioavailability. The present study aims to establish whether administration of different blood transfusions result in increased circulating fHb levels and NO consumption with effects on arterial NO-dependent blood flow in patients undergoing CABG surgery., Methods: Ninety-five consecutive patients undergoing elective CABG surgery were prospectively divided in four groups based on blood transfusion requirements during surgery: stored blood cells (SBC, n. 21), intraoperative autologous salvaged blood (ASB, n. 25), SBC and ASB (n.22), no transfusion (control, n. 27). Blood samples were collected before and after intervention to analyse plasma levels of fHb and NO consumption. Endothelium-dependent relaxation was assessed in left internal mammary artery (LIMA) rings harvested before chest closure. Peripheral artery tonometry was assessed after intervention., Results: Transfusions with SBC increased plasma fHb (p<0.05). Transfusions of ASB resulted in higher plasma fHb compared to SBC (p<0.01). fHb concentrations directly correlated with NO consumption (r=0.65, p<0.001). Maximal endothelium-dependent relaxation in LIMA was significantly attenuated in SBC and ASB patients compared to control (15.2±3.1% vs 21.1±2.5% vs 43±5.0% respectively; p<0.01). Significant correlations were identified between the aortic pressure wave velocity, plasma fHb concentration and NO consumption (p<0.01)., Conclusions: Intraoperative blood transfusions and particularly autologous salvaged blood impair endothelium-dependent relaxation through NO scavenging by fHb. These findings obtained in vitro and in vivo provide new insights into the adverse relation between blood transfusions and patient outcome., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins., Material and Method: Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution., Results: The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units., Conclusions: The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases., (Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods., Methods: Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative In-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS)., Results: The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1., Conclusion: Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.

Purpose of Review: To describe the recent developments in the strategies to reduce allogeneic blood transfusions with emphasis on the impact on clinical outcomes., Recent Findings: Concerns over the safety, efficacy, and supply of allogeneic blood continue to necessitate its judicious use as the standard of care. Patient blood management is emerging as a multidisciplinary, multimodality strategy to address anemia and decrease bleeding with the goal of reduced transfusions and improved patient outcomes. Common risk factors for transfusion include anemia, blood loss, and inappropriate transfusion decisions. Several approaches are available to mitigate these. Recent data continue to support the effectiveness of various hematinics, hemostatic agents and devices, as well as intermittent discontinuation of anticoagulant therapy. Use of autotransfusion techniques, particularly cell salvage, is the other strategy with accumulating data supporting its safety and efficacy. Finally, implementation of evidence-based transfusion guidelines will help to target allogeneic blood to those patients who are likely to benefit from it and thus reduce or eliminate unnecessary exposure to blood., Summary: Patient blood management is the timely use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcome.

Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a fixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient's tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a "one-by-one" administration schedule. Evidence-based clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within well-constructed protocols will offer better prospects for blood conservation in selected IBD patients undergoing elective surgery.

A literature review and meta-analysis were undertaken to assess the clinical effectiveness of retrograde autologous priming of the cardiopulmonary bypass circuit to reduce allogeneic packed red blood transfusions in adult cardiac surgery. Structured searches of Medline, Embase, Cochrane Collaboration Library, Scopus, Cumulative Index to Nursing and Allied Health Literature and Science Direct were performed to identify randomized trials comparing retrograde autologous priming to a prospective control group. A total of 21,643 studies were identified and eighteen trials were retrieved for full-text review. Six trials met eligibility criteria. Pooled estimates demonstrated that retrograde autologous priming significantly reduced the number of patients receiving intraoperative packed red cell transfusions (OR=0.36; 95% CI: 0.13, 0.94; P=0.04, I(2)=47.5%), total hospital stay packed red cell transfusions (OR=0.26; 95% CI: 0.13, 0.52; P=0.0001, I(2)=0%), and the number of units transfused of total hospital stay packed red blood cells (WMD=-0.60; 95% CI: -0.90, -0.31; P=0.0001, I(2)=0%). Retrograde autologous priming, however, did not provide a clinical benefit in reducing the number of units transfused of intraoperative packed red blood cells (WMD=-0.29; 95% CI: -0.59, 0.01; P=0.05). The combined patient population studied in the six trials was mainly primary isolated coronary artery bypass surgery. Assessing the safety of retrograde autologous priming was not possible due to limited data.

In addition to more restrictive "transfusion triggers", presently available allogeneic blood conservation strategies in surgery include preoperative increase in red blood cells (RBC) mass, techniques or pharmaceutical agents that reduce blood loss, and perioperative blood salvage. Because of very important risk reduction in allogeneic blood, benefit/risk of preautologous blood donation (PAD) is quite questionable at this moment. Indeed, at this moment in France, we focus to avoid any transfusion (allogeneic and autologous blood). Therefore the most important techniques used are pharmacological: erythropoietin before surgery with a number of injections related to baseline Hb, and tranexamic acid during and after surgery. Cell saving is used only if bleeding is enough important like arthroplasty revisions. All blood conservation techniques carry their own efficiency limits, constraints and risks that, in addition to institutional considerations and individual patient characteristics are determinant to settle a blood conservation strategy. The choice of a technique should take into account (a) the delay before surgery, (b) the anticipated blood loss for the procedure that varies among institutions, (c) the tolerable blood loss without transfusion for the patient, and (d) the efficacy of the blood conservation technique in the given setting. Nevertheless, at this moment in France, it is quite important to notice that the risk of delay or lack of transfusion induces much more deaths that the transfusion itself during or after anesthesia [Anesthesiology 105, 1087-97].

Blood transfusions after cardiac surgery are very common, and the rates are highly variable among institutions. Transfusion carries the risk of infectious and noninfectious hazards and is often clinically unnecessary. This article discusses the history of bloodless cardiac surgery, the hazards of transfusion, the benefits of reducing or eliminating transfusion, and strategies to conserve blood. It also provides a list of resources for those who are interested in learning more about bloodless care.

Objective: To evaluate the efficacy of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS) in blood-conservation strategies for infrarenal aortic surgery., Summary Background Data: Recent concerns over the risks of transfusion-related infection have resulted in sharp rises in the cost of blood preparations. Autologous transfusion may be a safe alternative to allogeneic transfusion, which has been associated with immune modulation and postoperative infection., Methods: This multicenter prospective randomized trial compared standard transfusion practice with autologous transfusion combining ANH with ICS in 145 patients undergoing elective aortic surgery. The primary outcome measures were the proportion of patients requiring allogeneic blood and the volume of allogeneic transfusion. The secondary outcome measures were the frequency of complications, including postoperative infection, and postoperative hospital stay., Results: The combination of ANH and ICS reduced the volume of allogeneic blood transfused from a median of two units to zero units. The proportion of patients transfused was 56% in allogeneic and 43% in autologous. There were no significant differences in complications or length of hospital stay., Conclusions: Both ANH and ICS were safe and reduced the allogeneic blood requirement in patients undergoing elective infrarenal aortic surgery.

Safety of haemotransfusions remains a challenge in modern transfusion medicine. Methodological approaches toward eliminating risks for haemotransfusion complications include a wider employment of principles of haemocomponent therapy, prevention of a possibility of infections contamination of blood and its components, deleukocytation of blood components, categorizing of donors by phenotypes, registering those donors having been phenotyped, categorizing of potential recipients by phenotypes, screening of alloimmune antierythrocytic antibodies in donors, sick and pregnant women, introduction of autodonation on a wide scale.

Background: Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion., Methods: To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases., Results: A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery)., Interpretation: Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.

Background: Preoperative autologous blood donation is commonly used to reduce exposure to allogeneic transfusions among patients undergoing elective cardiac surgery. However, this technique is associated with an overall increase in transfusions (allogeneic or autologous). The authors assessed the impact of transfusion decision-making on the effectiveness of preoperative autologous donation in reducing the frequency of allogeneic transfusions, and its impact on the increased transfusion rate associated with preoperative autologous donation in cardiac surgery., Methods: This retrospective analysis compared transfusion practices among 176 patients who predonated autologous blood before elective cardiac surgery and 176 matched cardiac surgery patients who did not predonate blood. The impact of decision-making on transfusion exposure was determined using multivariate analyses to account for major perioperative interventions and complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for exposure to allogeneic blood transfusion or any transfusion, before and after exclusion of transfusions not conforming with selected transfusion criteria., Results: Exposure to allogeneic transfusion was more likely among patients who did not predonate blood than among those who did predonate blood (OR 14.0, 95% CI 5.8-33.8). This finding was still true after exclusion of transfusions not meeting the transfusion criteria (OR 19.3, 95% CI 6.7-55.7). The autologous blood donors were more likely than the nondonors to receive any transfusion (OR 10.8, 95% CI 5.7-20.3). However, this association was substantially attenuated after exclusion of transfusions not meeting the transfusion criteria (OR 1.9, 95% CI 1.1-3.2)., Interpretation: Patients who predonated blood before elective cardiac surgery were at lower risk of receiving allogeneic transfusions than the nondonors. This was not because of a deliberate withholding of allogeneic transfusions from autologous donors. However, more liberal transfusion criteria for autologous blood were largely responsible for the increased transfusion rate among the autologous donors.

Therapeutic regimens involving the transfusion of blood components are a matter of debate, not only with regard to patients' safety, but also with regard to cost-effectiveness. The following different measures to reduce the use of blood components and their efficacy are discussed: autologous transfusion, including predonation, isovolaemic haemodilution and peri-operative retransfusion; toleration of a lower haematocrit; and measures to reduce blood loss. In particular, a combination of these methods may be most effective at reducing transfusion needs.

Unlabelled: The separation of whole blood into components is the state-of-the-art in transfusion of allogeneic blood. The main reasons are the negative effects of the buffy coat and the need for FFP. Nevertheless, especially in Germany whole blood is being rejected more and more even as autologous blood. However, most of the negative effects of the buffy coat do not apply to autologous blood. Additionally, these patients usually do not develop coagulation disorders and therefore do not need plasma as a hemostatic component. On the other hand, separation into components of autologous blood leads to an increase of costs and to logistic problems that restrict autologous blood predeposit to a few institutions. Therefore, we have reviewed the literature in order to find a scientific basis for this., Methods: We analysed all articles listed by MEDLINE during the last 12 years that dealt with the quality of whole blood or red cell concentrates. In addition, all references were included that contributed relevant information to the topic. A total of 135 original articles, abstracts, reviews, letters or editorials were analysed that referred to standard preparations and storage media. In 48 papers the in vivo red cell survival was studied. 28 of which fulfilled the prerequisites to be included into a meta-analysis. The following in vitro parameters were also evaluated: pH, potassium load of the units, ATP and DPG concentration of the red cells., Results and Discussion: Whole blood (resuspended in CPDA-1) and red cell units (stabilized in CPDA-1 or additive solutions) with a different buffy coat or leucocyte content have comparable pH values and red cell 2,3-DPG and ATP concentrations at the end of the approved storage time. The potassium load of a whole blood unit appears to be higher than red cell concentrates, but this is to some extent caused by the higher plasma content of whole blood and is not thought to be a clinically relevant problem for patients receiving only a few units. A number of studies demonstrate that dependent upon the leucocyte content of a red cell unit, leucocyte metabolites and enzymes are released and accumulate during storage. A detrimental influence on the integrity of the red cell membrane was found in several in vitro studies. Nevertheless, a significant improvement in red cell survival by leucocyte reduction was detected by only one group. Undoubtedly, nonhemolytic febrile transfusion reactions (NHFTR) are generally caused by an antibody-antigen interaction due to the transfusion of allogeneic buffy coat. On the other hand, there is some evidence that non-specific immunological mechanisms such as the release of histamine or cytokines are also capable of causing NHFTR. Thus, these reactions are expected to occur in autologous blood transfusion. However, so far, there are no data about the frequency and severity of these reactions and whether they are more likely to emerge after transfusion of blood units with a particular preparation. Blood transfusions can cause septic complications due to bacterial contamination of the transfused units. These fatal but rare complications may be reduced by pre-storage filtration of blood, but there is no indication that buffy coat reduction is effective. Three cases with septic complications have been reported after autologous transfusion, in two of which red cell concentrates (at least one was free of buffy coat) had been used. Thus, there is no justification for the conclusion that the risk of septic complications is increased by transfusion of whole blood. After all, whole blood and red cell concentrates exhibit only minor differences in relevant in vitro parameters. Hence, a higher incidence of adverse effects following the transfusion of autologous whole blood compared to autologous red cell concentrations is unlikely. Therefore, the 24 h in vivo recovery is considered to be the most valid criterion to assess the quality of red cell preparations.(ABSTRACT TRUNCATED)

The safety of autologous blood donation by "high-risk" patients (those with some preexisting medical conditions) has been questioned. The authors reviewed 1393 consecutive blood donation records (207 high-risk autologous [HRA], 665 non-high-risk autologous [NHRA], and 521 directed donors [DD]) to determine the safety and outcome of blood donation by HRA patients as compared with other donors at their center. The HRA group included patients with a history of significant coronary artery on cerebral vascular disease, recent seizures, cardiac arrhythmia, chronic heart failure, valvular or congenital heart disease, symptomatic dyspnea, insulin-dependent diabetes and/or current therapy with two or more antihypertensive medications. Those designated NHRA were all other autologous donors; DD met all criteria for homologous donation. Donor characteristics including predonation hematocrit, pre- and postdonation mean arterial pressure and heart rates were similar in all groups. Eight HRA donors (3.9%) had reactions, compared with 21 NHRA (3.2%) and 23 DD (4.4%), a difference that was without statistical significance. The reaction rate in all autologous donors (HRA and NHRA) was 3.4%. No differences in symptoms reported, hemodynamics or reaction severity were observed among the three groups (P > .05). A multiple logistic regression was performed within and among the groups with the risk factor categories listed above and medication classes including beta blockers, cardiac glycosides, calcium-channel blockers, antihypertensive agents, nitrates, and antiarrhythmic agents (chi 2 = 14.9; P = .0006). Only first-time donation (P = .0001) and cardiac glycoside usage (P = .04) were positively associated with an untoward reaction. The authors conclude that donation by HRA donors is at least as safe as that by donors who meet homologous donation criteria in their population and setting.

Adverse effects of the transfusion of homologous blood on tumor recurrence and resistance to bacterial infection have been reported previously, but the findings are inconclusive. A retrospective review of patients undergoing orthopedic surgery was conducted, and the rate of the postoperative infectious complications was compared among those receiving homologous blood, autologous blood, both types, or no transfusion support. An overall postoperative infection rate of 6.1 percent was observed: 6.9 percent among persons receiving homologous blood, 5.0 percent among those receiving autologous blood, 11.9 percent among those receiving both homologous and autologous blood, and 4.9 percent among those not receiving transfusions (p = 0.37). Among patients receiving homologous blood, a subset of 15 patients received homologous whole blood and had an infection rate of 20 percent. Significant predictors of postoperative infection included increasing age, spinal surgery, high admission hematocrit, and greater time in surgery. Of factors relating to transfusion, only the use of homologous whole blood was a significant predictor of postoperative infection, which suggests a detrimental effect of homologous plasma. It can be concluded that, in this group of patients undergoing relatively nontraumatic surgery, several variables that are not related to transfusion, as well as the use of homologous whole blood, were significant predictors of postoperative infection.

Recent enthusiasm for intraoperative autotransfusion has overshadowed critical assessment of its potential risks. In this study, adult mongrel dogs underwent controlled intraperitoneal hemorrhage of twice their estimated blood volume over a 4-hour period. The blood was replaced by an equal volume of banked blood (Group I, n = 5), or collected and reinfused via the Sorenson System (Group II, n = 6), or the Haemonetics Cell Washing Device (Group III, n = 6). Acid citrate dextrose was the local anticoagulant for Groups I and II, and heparin for Group III. Pulmonary capillary wedge pressure and cardiac output were maintained at baseline values with crystalloid infusion. Core temperature, pO2, and systemic pH remained normal throughout the 4 hours of evaluation. Red blood cell recovery was efficient in all animals, and the 2,3 DPG levels remained normal in the autotransfused dogs. Thrombocytopenia, however, developed uniformly and was more pronounced after autotransfusion. Platelet numbers decreased nearly 45% in the Sorenson as well as Haemonetics animals. Additionally, platelet dysfunction occurred after one blood volume exchange as evidenced by prolonged bleeding times and loss of the secondary wave on Sonoclot profiles. Coagulation studies revealed progressive consumptive coagulopathy and fibrinolysis in autotransfused dogs. The P.T., P.T.T., and T.T. lengthened, and levels of factors II, V, VIII, and fibrinogen fell. Autotransfusion clearly eliminates the infectious and incompatibility problems of banked homologous blood. Despite advances in technique, however, consumptive coagulopathy, fibrinolysis, and platelet dysfunction occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Many factors already contribute to limit the amount of bank blood available for therapeutic use; a possible reduction in the amount of available blood could stem from the relative indifference of young people towards the gift of blood and the increase in the size of the pool of positive carriers of Australian antigen. Moreover, new operations appear (coronary by-pass) which increase the demand for blood. It is imperative that we adopt attitudes and practice techniques that will contribute to the conservation of blood. This paper discusses the advantages of an active blood bank committee which, alone, can reduce the consumption of blood by 20 percent. Moreover, actual techniques for conservation of blood are reviewed: controlled hypotension, haemodilution and intraoperative blood salvage.